Diabetes Services. Unless otherwise covered under a Prescription Drug Rider or Policy, coverage is included for drugs, including insulin, equipment, agents, and Orthotics used for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and non-insulin-using diabetes when prescribed by a health care professional legally authorized to prescribe such items and are mandated by law. Equipment, agents, and Orthotics shall include:
Diabetes Services. Diabetes Self-Management and Training and Education Services "Diabetes self-management training and educational services" means instruction in an inpatient or outpatient setting which enables diabetic patients to understand the diabetic management process and daily management of diabetic therapy as a method of avoiding frequent hospitalizations and complications, when the instruction is provided in accordance with a program in compliance with the National Standards of Diabetes Self-Management Education Program as developed by the American Diabetes Association. Diabetes self-management training and educational services includes coverage for medical nutrition therapy when prescribed by a health care professional and when provided by a certified, registered or licensed health care professional. Diabetes self-management training and educational services does not include programs with the primary purpose of weight reduction. Benefits also include medical eye exams (dilated retinal exams) and preventive foot care, and diabetic specific foot orthotics, orthopedic shoes, inserts, modifications, and footwear when Medically Necessary for the treatment of complications related to diabetes. Outpatient self-management training for the treatment of diabetes, education and medical nutrition therapy services when services are ordered by a Physician and provided by appropriately licensed, certified or registered health care professionals. The provider certifies the services are necessary for the treatment of: • Insulin using diabetes; • Non-insulin using diabetes; • Elevated or impaired blood glucose levels induced by Pregnancy; or • Elevated or impaired blood glucose levels induced by prediabetes in accordance with the American Diabetes Association’s standards. Diabetes self-management training includes training provided to you after the initial diagnosis of diabetes and or Pregnancy induced elevated blood glucose levels in the care and management of those conditions, including nutritional counseling and proper use of the diabetic self-management items listed below. Benefits are also provided for additional training upon diagnosis of a significant change in medical condition that requires a change in the self- management regime, and periodic continuing education training as warranted by the development of new techniques and treatment for diabetes. Diabetic Self-Management Supplies Benefits for blood glucose control and testing including insulin syringes with needles, bloo...
Diabetes Services. This benefit has one or more exclusions as specified in the Exclusions Section. Covered Benefits are provided if you have insulin dependent (Type I) diabetes, non-insulin dependent (Type 2) diabetes, and elevated blood glucose levels induced by pregnancy (gestational diabetes). We will guarantee Coverage for the equipment, appliances, Prescription Drug/Medications, insulin or supplies that meet the United States Food and Drug Administration (FDA) approval, and are the medically accepted standards for diabetes treatment, supplies and education.
Diabetes Services. This benefit has one or more exclusions as specified in the Exclusions Section. Covered Benefits are provided if you have insulin dependent (Type I) diabetes, non-insulin dependent (Type 2) diabetes, and elevated blood glucose levels induced by pregnancy (gestational diabetes). We will guarantee Coverage for the equipment, appliances, Prescription Drug/Medications, insulin or supplies that meet the United States Food and Drug Administration (FDA) approval, and are the medically accepted standards for diabetes treatment, supplies and education. Diabetes Education (Limited) The following benefits are available when received from a Practitioner/Provider who is approved to provide diabetes education: · Medically Necessary visits upon the diagnosis of diabetes · Visits following a Practitioner/Provider diagnosis that represents a significant change in condition or symptoms requiring changes in the patient’s self-management · Visits when re-education or refresher training is prescribed by a healthcare Practitioner/Provider with prescribing authority · Telephonic visits with a Certified Diabetes Educator (CDE) · Medical nutrition therapy related to diabetes management Approved diabetes educators must be part of our In-Network Practitioners/Providers who are registered, certified or licensed Healthcare Professional with recent education in diabetes management. Diabetes supplies and services The following equipment, supplies, appliances, and services are Covered when prescribed by your Practitioner/Provider and when obtained through the designated network Provider: · Preferred insulin pumps - Some services require Prior Authorization. Refer to your Formulary for Preferred insulin pumps. · Specialized monitors/meters for the legally blind. · Medically Necessary Covered Podiatric appliances for prevention of feet complications associated with diabetes. Refer to the Durable Medical Equipment Benefits Section. · Preferred Prescriptive diabetic oral agents for controlling blood sugar levels – refer to your Formulary for Preferred agents. · Glucagon emergency kits. · Preferred insulin – refer to your Formulary for Preferred insulin. · Syringes. · Injection aids, including those adaptable to meet the needs of the legally blind. · Preferred blood glucose monitors/meters – refer to your Formulary for Preferred monitors. · Preferred test strips for blood glucose monitors – refer to your Formulary for Preferred test strips. · Preferred lancets and lancet devices. · Preferred ...
Diabetes Services. Diabetes Self-Management and Training and Education Services "Diabetes self-management training and educational services" means instruction in an inpatient or outpatient setting which enables diabetic patients to understand the diabetic management process and daily management of diabetic therapy as a method of avoiding frequent hospitalizations and complications, when the instruction is provided in accordance with a program in compliance with the National Standards of Diabetes Self-Management Education Program as developed by the American Diabetes Association. Diabetes self-management training and educational services includes coverage for medical nutrition therapy when prescribed by a health care professional and when provided by a certified, registered or licensed health care professional. Diabetes self-management training and educational services does not include programs with the primary purpose of weight reduction. Benefits also include medical eye exams (dilated retinal exams) and preventive foot care, and diabetic specific foot orthotics for, orthopedic shoes, inserts, modifications, and footwear when Medically Necessary for the treatment of complications related to diabetes. Diabetic Self-Management Supplies Benefits for blood glucose control and testing including insulin syringes with needles, blood glucose and urine test strips, lancets and lancet devices, ketone test strips and glucose tablets, and single measurement glucose monitors, including those for the legally blind, and certain insulin pumps, are described under the Outpatient Prescription Drugs section. Continuous glucose monitors and certain insulin pumps are subject to all the conditions of coverage stated under Durable Medical Equipment (DME).
Diabetes Services. Diabetes Self-Management and Educational Services For Covered Persons with Type 1 or Type 2 diabetes, the following services are offered at $0 cost share: • Retinal eye exams, limited to 1 exam per plan year. • Certain lab tests specifically used to assess lipid levels, kidney function (including metabolic and urine) and glucose control (HgbA1C) in diabetics This does not apply to Covered Persons with pre- diabetes or gestational diabetes diagnoses. Depending upon where the Covered Health Care Service is provided, Benefits for diabetes self-management and training/diabetic eye exams/foot care will be the same as those stated under each Covered Health Care Service category in this Schedule of Benefits. SAMPLE
Diabetes Services. Diabetes Self-Management and Educational Services For Covered Persons with Type 1 or Type 2 diabetes, the following services are offered at $0 cost share: • Retinal eye exams, limited to 1 exam per plan year. • Certain lab tests specifically used to assess lipid levels, kidney function (including metabolic and urine) and glucose control (HgbA1C) in diabetics. This does not apply to Covered Persons with pre- Depending upon where the Covered Health Care Service is provided, Benefits for diabetes self-management and training/diabetic eye exams/foot care will be the same as those stated under each Covered Health Care Service category in this Schedule of Benefits. Note: Your vPCP or PCP must submit an electronic referral before services are rendered by a Network Specialist or other Network Physician in order for benefits to be payable under this Policy. Amounts which you are required to pay as shown below in the Schedule of Benefits are based on Allowed Amounts or, for specific Covered Health Care Services as described in the definition of Recognized Amount in the Policy, Recognized Amounts. The Allowed Amounts provision near the end of this Schedule of Benefits will tell you when you are responsible for amounts that exceed the Allowed Amount.
Diabetes Services. In addition to Medically Necessary Covered Services for treatment of diabetes additional benefits are provided as follows:
Diabetes Services. Medically Necessary Diabetes treatment, as determined by HMO, includes:
Diabetes Services. Diabetes Self-Management and Training and Education Services "Diabetes self-management training and educational services" means instruction in an inpatient or outpatient setting which enables diabetic patients to understand the diabetic management process and daily management of diabetic therapy as a method of avoiding frequent hospitalizations and complications, when the instruction is provided in accordance with a program in compliance with the National Standards of Diabetes Self-Management Education Program as developed by the American Diabetes Association. Diabetes self-management training and educational services includes coverage for medical nutrition therapy when prescribed by a health care professional and when provided by a certified, registered or licensed health care professional. Diabetes self-management training and educational services does not include programs with the primary purpose of weight reduction. Benefits also include medical eye exams (dilated retinal exams) and preventive foot care, and diabetic specific foot orthotics including depth shoes or custom molded shoes, orthopedic shoes, inserts, modifications, footwear when Medically Necessary for the treatment of complications related to diabetes, and any other device, medication, equipment or supply for which coverage is required under Medicare guidelines pertaining to diabetes management. For the purpose of this Benefit the following terms have the following meanings: SAMPLE
